Provider Demographics
NPI:1568027886
Name:CLARKE, WENDY MAXINE (APRN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MAXINE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 N FLORIDA MANGO RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6416
Mailing Address - Country:US
Mailing Address - Phone:561-683-0302
Mailing Address - Fax:561-683-9823
Practice Address - Street 1:931 VILLAGE BLVD STE 904
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1939
Practice Address - Country:US
Practice Address - Phone:561-683-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11001689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily